title: [Determinants of support for dementia patients in general practice: a qualitative approach based on an epidemiological cohort].
abstract: BACKGROUND
  the analysis of access to diagnosis and care pathway for dementia patients shows that the disease is not considered as a priority for the general practitioner (GP). Different studies have point out under diagnosis of dementia.
  
  
  OBJECTIVE
  the purpose of this qualitative study was to document the determinants of the diagnosis and management of dementia by GP.
  
  
  METHODS
  recruitment of GPs (n = 12) was made from incident cases of dementia who were identified during the follow-up of subject enrolled in the 3 Cities cohort study. A semi-structured interview was conducted with an interview guide focused on the experience of the doctors. A phenomenological and pragmatic analysis, taking into account all the linguistic and extra linguistic evidence contained in the transcript was conducted.
  
  
  RESULTS
  several emerging categories have been described: the doctors believe that the management of Alzheimer's disease is a public health problem and not an individual, the positioning of the GP in the care system is central. Determinants that influence the management are the identity of the physician, the impression of a fuzzy nosology, the finding of a therapeutic ineffectiveness, the priority given to severe co-morbidities and the workload of the general practitioner. However, the ordering of these categories according to the pragmatic phenomenological approach showed that the identity of the doctor, professional and personal, is at the origin of behavioral variability in their medical care.
  
  
  CONCLUSIONS
  in a context of increased workload, the GP favors the assumption of comorbidities in the elderly given fuzzy nosology of dementia and uncertainty about the therapeutic efficacy. The phenomenological approach allows understanding that the human identity of the doctor, personal and professional identity, is the major factor that influence its care attitude for demented patients.
authors.affiliation: Département de médecine générale, Université Montpellier I, France.
authors.forename: Agnès Oude
authors.initials: AO
authors.lastname: Engberink
authors.forename: Clément
authors.initials: C
authors.lastname: Pimouguet
authors.forename: Michel
authors.initials: M
authors.lastname: Amouyal
authors.forename: Olga
authors.initials: O
authors.lastname: Gerassimo
authors.forename: Gérard
authors.initials: G
authors.lastname: Bourrel
authors.forename: Claudine
authors.initials: C
authors.lastname: Berr
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D001291:Attitude of Health Personnel; D015331:Cohort Studies; D015897:Comorbidity; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D005602:France; D058006:General Practice; D005853:Geriatrics; D006292:Health Priorities; D006801:Humans; D033183:Interdisciplinary Communication; D007407:Interviews as Topic; D010819:Physician's Role; D012017:Referral and Consultation; D016896:Treatment Outcome; D016526:Workload
keywords: Alzheimer's disease; dementia; diagnosis general practice; phenomenological-pragmatical approach; qualitative study